Virginia Tech's Larger Lessons

Bergeron, Mary Ann, Behavioral Healthcare Executive

The April 16 Virginia Tech incident focuses challenges and opportunities for Virginia and most states within their mental health treatment systems. Our nation has the opportunity to publicly recognize the prevalence of mental illness, which affects one in four adults and one in five children. We can admit how it impacts lives, emphasize yet again the nuud for access to treatment, and encourage early intervention and treatment.

The Virginia Tech incident also shined a national spotlight on mandator}' outpatient commitment (also known .is assisted outpatient treatment). Community services boards (('SBs) and behavioral health authorities (Bl IAsI .nv the local government agents that have responsibility under Virginia law tor many of the clinical and administrative aspects of the involuntary commitment process.

Prior to April 16, outpatient treatment orders were rarely used in Virginia. The law was seen as lacking Clarity in terms of enforcement and consequences. For the past four years, stronger mandatory outpatient treatment laws, based on New York's Rendras Law, have been proposed in Virginia, but none has become law tor reasons as varied as t heorganizations and individuals who supported or opposed the legislation.

In January ot this year, with a new set of mandatory treatment proposals looming in the Virginia General Assembly, a stakeholder leadership group formed by the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services wanted to become as well-educated as possible about mandatory outpatient treatment. Marvin S. Swartz, MD, of Duke University Medical ('enter, was invited to present his research on mandatory outpatient treatment before the group. Dr. Swartz is neither a proponent nor an opponent ot such treatment, but rather is a well respected researcher. I Ie presented data from studies in North Carolina and New York State, and he cited opposing groups main areas of passionate disagreement on mandatory outpatient treatment:

* reliability of the evidence and outcomes that support the benefit of the approach;

* criteria for the size and nature of the population to be targeted; and

* the reach of mandated outpatient treatment, including length of time for an order, services needed, provisions, and sanctions.

What appeared to be effective in both studies are intensive services, assertive outreach and engagement. mìl\ access to community supports that promote stability. Questions continue to revolve around the effectiveness of a mandatory outpatient treatment law without such services in place- to support the law. Questions also remain about the court infrastructure needed to support due process and the points of the court's intersection with the individual. The data appear to be inconclusive as to the eflectiveness ol an outpatient commitment law alone. Concerns about adequate- resources ( Virgina ranks in the lowest ten states for providing funds for community services), infrastructure, and the potential reprioritizing ol populations, which would reduce services to those who voluntarily seek treatment, all have been considered during the past lour years.

This year, persons receiving mental health services strongly objected to the latest proposed mandatory outpatient treatment lau. Additionally, the Virginia Commission on Mental I lealth law Reform had begun in late 2006 a comprehensive study ot all involuntary commitment and treatment laws, with recommendations due to the legislature this fall. Considering these factors and many others, some having to do with available resources tor mental health funding. the- Virginia Cenerai Assembly decided against such proposals by February 24, and the current law remains in effect.

Then came the Virginia Tech shootings.

After April 16, Virginia Gov. Firn Kaine responded immediately to this incident by issuing an executive order to close a loophole in Virginia's gun laws. …

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